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This Is A Custom Widget

This Sliding Bar can be switched on or off in theme options, and can take any widget you throw at it or even fill it with your custom HTML Code. Its perfect for grabbing the attention of your viewers. Choose between 1, 2, 3 or 4 columns, set the background color, widget divider color, activate transparency, a top border or fully disable it on desktop and mobile.

• POD #0: Patient was hypotensive. He received a one-liter bolus of normal saline and 250 mL 5% albumin bolus which improved his hypotension.

• POD #1: Patient had acute blood loss anemia from his ileal loop. His hemoglobin was 6.0 g/dl. The decision was made to transfuse him with two units of packed red blood cells.

• During the transfusion, the patient became acutely dyspneic and hypertensive.

Assessment and Management:

• Patient was evaluated and showed signs of increased work of breathing.

• He was placed on noninvasive positive pressure ventilation (NPPV).

• He was hypertensive with his oxygen saturations in the low 90’s.

• Differential diagnosis at this point included TACO or an acute pulmonary embolism.

• CXR showed nonspecific interstitial opacities.

• Ruling out a pulmonary embolism was difficult. CT angiogram could not be performed due to the patient’s kidney disease. V/Q scans are often indeterminate. An ultrasound doppler study of his lower extremities was negative for deep venous thrombosis. An echocardiogram did not show evidence of right heart strain although it did show pulmonary hypertension.

• A discussion did arise to treat the suspected pulmonary embolism with anticoagulation. It was decided that anticoagulation would not be wise in this patient who had active blood loss in the past day.

• Given this information, the ICU team made the decision to diurese the patient.

• As the patient was diuresed, his NT-pro-BNP levels decreased and his clinical picture improved. He was taken off of the NPPV on POD #3.

Discussion:

• Acute pulmonary embolism can also cause an increase in NT-pro-BNP levels due to increased right heart strain.4 NT-pro-BNP levels are usually lower in acute pulmonary embolism than diseases which affect the left ventricle such as CHF.5

• The specificity of NT-pro-BNP levels in acute pulmonary embolism decreases with increasing levels of NT-pro-BNP.5

• Tobian et al., performed a case control study on 40 participants who had pre and post transfusion NT-pro-BNP levels recorded. Their study found the sensitivity of NT-pro-BNP to diagnose TACO to be 93.8% and the specificity to be 87.5%.3

• NT-pro-BNP levels can be a useful marker to help diagnose transfusion-associated circulatory overload.

• It can also be useful in the management of disease progression or regression.

• In this case, as the NT-pro-BNP levels decreased, the patient clinically improved.

• Due diligence must be performed when making any diagnosis. A single laboratory test cannot be used to make a diagnosis.

• Further research must be performed to specifically correlate laboratory values to specific disease states.